Buenos Aires, Argentina (UroToday.com) Shahrokh Shariat, Professor University of Vienna, discussed the awareness/prevention, earlier detection, current diagnostics, risk stratification, current therapies and follow-up of upper tract TCC.
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Upper tract is different from bladder TCC as shown by microsatellite instability (i.e. Lynch syndrome) and other prognostic factors previously shown to be adverse predictors for outcome. Prevention begins with smoking cessation with cessation > 10 years reduces upper tract TCC risk significantly. Public awareness of risk factors including geographic and environmental are imperative (i.e Balkan nephropathy). Imaging with CT urogram has high sensitivity and specificity at 98% and 99%, respectively. Newer technology allows improved tissue yield, however, at present we are seeking to improved ways to increase diagnostic yield. Risk stratification tools are accurate in 77% of patients with misclassification in many patients and lack of evidence to support current guideline recommended risk stratification. Treatments using endoscopic methods have higher risk of intravesical recurrence than resection. Lymphadenectomy is guideline-recommended and underutilized and there lacks standardized templates and extent of resection in which patients. Nephroureterectomy is a potentially curable procedure and segmental resection as well when performed in the correct patients. Single postoperative intravesical instillation at time of surgery decreases risk of intravesical recurrence. Neoadjuvant chemotherapy is being increasingly explored especially considering risk of patients inability to undergo adjuvant therapy given risk of renal failure. Unfortunately, upper tract TCC is a lethal disease with limited new developments. At my institution, we perform nephroureterectomy with template node dissection (including pelvic nodes if lower third ureter involved) as well as intraoperative mitomycin C instillation. Adverse pathology and renal function determines adjuvant therapy.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.